The Evolving Landscape of Prior Authorization

By Dr. Yan Chow, Sr. Director, Transformation, Automation Anywhere

Long a cornerstone of cost control in healthcare, prior authorization (PA) requires healthcare providers to obtain prior approval from health insurers for certain medical services, procedures, or medications before payment coverage is issued. While designed to ensure medical necessity and appropriate utilization, the PA environment is riddled with widespread challenges for providers, patients, and payers alike. This white paper will delve into the current PA landscape, highlight the impact of new federal regulations, and explore the transformative potential of AI agents and agentic automation to improve PA and enable adaptive compliance.